单纯经胸超声心动图引导卵圆孔未闭封堵术早期安全性及有效性分析

Evaluation of the safety and efficacy of patent foramen ovale closure guided by transthoracic echocardiography

目的分析单纯经胸超声心动图(TTE)引导卵圆孔未闭(PFO)封堵术的早期安全性及有效性。方法回顾性分析2019年3月至2022年12月于北京大学第三医院行TTE引导PFO封堵术的患者资料,共纳入403例,其中脑卒中患者145例,偏头痛患者258例。观察围手术期及术后3个月严重手术并发症及脑卒中/短暂性脑缺血发作是否复发,评估手术的安全性;采用配对t检验比较术前及术后3个月偏头痛患者的缓解程度[头痛影响测评量表6(HIT6)评分、头痛持续时间、头痛发作频率],评估手术的有效性。结果403例PFO封堵术患者中,20例患者因鞘管无法通过而终止手术,手术成功率为95.04%(383/403);手术时间为(23.3±7.3)min;在严重手术并发症方面,发生心包积液者13例(3.23%,13/403)、冠状动脉气体栓塞者4例(0.99%,4/403),未见封堵器脱落移位、外周血管损伤等并发症。4例冠状动脉气体栓塞患者经对症处理后好转;13例心包积液患者中,11例经心包穿刺引流后好转,2例紧急开胸探查止血,术中发现均为左心耳穿孔,经对症处理后好转出院。所有患者完成术后3个月随访,未发现封堵器移位、心包积液、主动脉瓣关闭不全等并发症;脑卒中患者未发现脑卒中/短暂性脑缺血发作复发;偏头痛患者术后3个月HIT6评分、头痛发作频率、发作时间较术前均明显减少[(43.6±5.6)分vs(57.8±6.7)分;(2.4±0.6)次/月vs(6.4±2.3)次/月;(2.2±1.4)h/次vs(7.4±4.5)h/次],差异具有统计学意义(t=25.45、26.34、17.27,P均<0.001)。结论单纯TTE引导PFO封堵术是安全、有效的。

Objective To analyze the early safety and efficacy of patent foramen ovale(PFO)occlusion guided by transthoracic echocardiography(TTE).Methods The data of 403 patients who underwent TTE-guided PFO occlusion in our hospital from March 2019 to December 2022 were analyzed retrospectively,including 145 patients with stroke and 258 with migraine.We observed the severe surgical complications,the recurrence of stroke/TIA during perioperative period and 3 months after operation,and evaluated their safety;We compared the remission degree of migraine(headache impact test 6[HIT6],frequency and time of headache attack)by paired t-test before and 3 months after operation,and evaluated its effectiveness.Results 403 cases of PFO occlusion were completed,and 20 patients stopped the operation because the sheath could not pass through,with a success rate of 95.04%(383/403).The average operation time was(23.3±7.3)min.In terms of severe surgical complications,there were 13 cases of pericardial effusion(3.23%,13/403)and 4 cases of coronary gas embolism(0.99%,4/403),and no complications such as the loss and displacement of occluder and peripheral vascular injury were found.4 cases of coronary gas embolism improved after symptomatic treatment;Among 13 cases of pericardial effusion,11 cases got better after pericardiocentesis and drainage,and 2 cases underwent emergency thoracotomy to stop bleeding.All cases were found to be left atrial appendage perforation during operation,and they were discharged after symptomatic treatment.All patients were followed up for 3 months after operation,and no complications such as occluder displacement,pericardial effusion and aortic valve insufficiency were found.No recurrence of stroke/TIA was found in stroke patients;Three months after operation,the average HIT6 score of migraine patients was(43.6±5.6),the average frequency of headache attack was(2.4±0.6)times/month,and the average attack time was(2.2±1.4)hours/time,which was significantly lower than that before operation[(43.6±5.6)scores vs(57.8±6.7)scores;(2.4±0.6)vs(6.4±2.3);(2.2±1.4)vs(7.4±4.5);t=25.45,26.34,17.27;all P<0.001].Conclusion TTE-guided PFO occlusion is safe and effective.